On this ___ day of ______________, 2004, I attest that the preceding/attached document(s) is/are a true, exact, complete and unaltered photocopy made me of _________(identify the original)__________________ presented to me by the document's / documents' custodian, ______(identify the custodian)_______, and, to the best of my knowledge the photocopied document is neither a public record nor a publicly recordable document, certified copies of which are available from an official source other than a notary public.